Increased emphasis on darkness and rejection of a diameter criterion represent paradigm shifts in the clinical diagnosis of melanoma

Comment on “The role of the ugly duckling sign in patient education”

“…It is most important to look for and recognize moles when they are ugly ducklings because they stand out, even focally, because of the appearance of darkness. 3,4 It is not a coincidence that the only 2 ugly duckling melanomas pictured in Grob and Bonerandi's article first describing the ugly duckling sign were small, dark macules. 5 Also, it is no coincidence that both of the melanomas in the Ilyas et al study are dark ugly ducklings.…”

A unifying approach to the clinical diagnosis of melanoma including “D” for “Dark” in the ABCDE criteria

“…Many of these proposed strategies, including the “D” for “Dark” proposal I offered, have also added emphasis on recognition of darkness as a particular feature of concern in pigmented lesions [5,10–12]. I have recently reviewed the compelling rationale for both an increased emphasis on darkness and rejection of the diameter criterion in the clinical diagnosis of melanoma [13]. The Georgia approach to melanoma diagnosis uniquely incorporates many elements of these strategies in a complementary manner to increase the sensitivity of diagnosis of early melanoma [13,14] (Figure 1).…”

“…I have recently reviewed the compelling rationale for both an increased emphasis on darkness and rejection of the diameter criterion in the clinical diagnosis of melanoma [13]. The Georgia approach to melanoma diagnosis uniquely incorporates many elements of these strategies in a complementary manner to increase the sensitivity of diagnosis of early melanoma [13,14] (Figure 1). …”